Bluebell Surgery

Updated 24 November 2021

Bluebell Surgery is located on the outskirts of Colchester at:

Jack Andrew Drive

Colchester

Essex

CO4 9YN

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures.

The practice is situated within the North East Essex Clinical Commissioning Group (CCG) area and delivers General Medical Services (GMS) to a patient population of approximately 4,050. This is part of a contract held with North East Essex CCG.

The practice is part of a wider network of five local GP practices.

Information published by Public Health England shows the deprivation within the practice population is in the 7th lowest decile. The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 89.7% White, 5% Asian, 2% Mixed, 1.9 % Black, and 1.4% Other.

The age distribution of the practice population has a lower concentration of older people than local averages.

The practice is registered as an individual provider practice owned by a single GP. The GP employs a part-time regular locum female GP and a full-time male salaried GP. Further regular locum GPs work for the practice as required. They are supported by two practice nurses, a practice manager, and administrative and reception staff. Staff work a range of hours including full and part-time.

Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance. Many GP appointments are telephone consultations however, if the GP needed to see a patient face-to-face this is offered.

Extended access is provided by the practice and the primary care network partner practices, and patients are directed to NHS 111 for healthcare outside practice opening hours.

Updated 24 November 2021

We carried out an announced inspection at Bluebell Surgery on 25 October 2021. Overall, the practice is rated as good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Requires Improvement

Following our previous inspection on 5 March 2019 the practice was rated requires improvement overall. Specifically, they were rated requires improvement for safe, effective and well-led services and good for caring and responsive services. We issued a requirement notice at this inspection for Regulation 17, Good Governance.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Bluebell Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This was a comprehensive inspection to follow-up on the breaches of the regulations identified at the last inspection, the other areas where we told them they should improve, and re-rate the practice.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

• The breaches found in the previous inspection had been complied with and actioned.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• We saw risk assessments were undertaken and actions taken when issues were found.
• Patients received effective care and treatment that met their needs. The patient records we reviewed showed care pathways and protocols were well managed and followed.
• Staff dealt with patients kindly and with respect, involving them in decisions about their care. This was explained to us when we spoke with patients when we visited the practice.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve prescribing data.
• Continue to improve childhood immunisation and cervical screening uptake.
• Continue to work on the practice strategy to embed it into the business as usual at the practice.
• Continue to develop an effective quality improvement programme, including clinical audit.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care